Healthcare Provider Details

I. General information

NPI: 1316316169
Provider Name (Legal Business Name): CAROL HUFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 EVANS MILL DR STE 306
DALLAS GA
30157-1623
US

IV. Provider business mailing address

57 JESSEL LN
DOUGLASVILLE GA
30134-5901
US

V. Phone/Fax

Practice location:
  • Phone: 404-500-9177
  • Fax:
Mailing address:
  • Phone: 404-316-3352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11402
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005664
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: